Public Health Approach to Violence Prevention

Many people are familiar with public health approaches to manage infection diseases. These approaches have been used to manage other infectious diseases like HIV, and non-communicable diseases like diabetes. A public health approach is also used in public safety. In the past 40 years, the Centers for Disease Control and World Health Organization have endorsed public-health strategies to prevent different forms of violence, including domestic violence, sexual assault, and terrorism or other mass attacks. 

The Centers for Disease Control defines public health as, “The collective actions and strategies of a society to improve population health.” This is broken down into the following 10 essential functions that fall under four categories:  

Assessment 

• Monitor Health 
• Diagnose and Investigate 

Policy Development 

• Inform, Educate, Empower 
• Mobilize Community Partnerships 
• Develop Policies 

Assurance 

• Enforce Laws 
• Link to/Provide Care 
• Assure Competent Workforce 
• Evaluate 

System Management 

• Research 

The public health approach incorporates experts from across disciplines—including educators, health care workers, mental health professionals, faith leaders, and law enforcement—to address a spectrum of needs. For additional details, view the CDC’s 10 Essential Public Health Services Overview.  

Core Activities

Public health utilizes evidence-based interventions through the following core activities:  

• Defining and surveillance of the problem through surveys or other ethical methods of data collection that do not violate personal privacy) 
• Identifying risk and protective factors 
• Developing and testing prevention strategies 
• Scaling up prevention strategies for widespread adoption

Each of these is relevant to preventing targeted violence. 

Socio-Ecological Model

Public health uses a socio-ecological lens to identify the personal and environmental risk and protective factors which determine health outcomes. It is especially interested in those risk and protective factors that can be modified. Dynamic risk factors include things such as: employment status, association with antisocial peers, and antisocial thinking patterns. Dynamic protective factors include safe and stable housing; healthy, positive relationships with others; and having strong social support networks.    

Prevention Pyramid

The public health approach to improving population health is focused on prevention which includes four levels: primordial, primary, secondary and tertiary.  These become more specialized as you move higher up the pyramid.   

Regarding targeted violence prevention, communities need help in building prevention capacities in the primary, secondary, and tertiary prevention spaces. Success in these spaces is highly dependent upon mobilizing community members, increasing trust, increasing capacities, and building community resilience.  

Primordial prevention involves identifying and implementing local, state and national-level public policies and laws to reduce the occurrence of risk factors and promote protective factors in the general population.  

Primary prevention involves reducing population-level risk factors (e.g. bullying, domestic violence, drug and alcohol use) and strengthening population level protective factors (e.g. linkage to mental health services).  To achieve this, communities need to leverage existing prevention assets and build new ones addressing the highest priority vulnerabilities so that vulnerable individuals get the help they need before they ever consider violence as a solution.   

Secondary prevention involves helping those individuals who are at risk for targeted violence with wrap-around services (such as from a behavioral threat assessment and management team) that enable them to diminish or cease their risk for potential violence.  One key to successful secondary prevention is strengthening intimate bystander reporting of risks for violence, in a way that enables early intervention before a crime is committed.  Another key is to have fully functioning behavioral threat assessment and management teams, both in schools and in the community.  Finally, it is necessary to have mental health professionals who are trained and capable of working with clients with risk for targeted violence.   

Tertiary prevention involves helping those individuals who have been convicted of a crime related to targeted violence with wrap-around services that enable them to diminish or cease their risk for further crimes related to targeted violence.  This requires the same elements as secondary prevention: behavioral threat assessment and management teams and mental health professionals.   

In Illinois, as in other states, we use the public health approach to help guide our efforts to prevent targeted violence. This training is part of that effort to build capacity at three of the four prevention levels, primary, secondary, and tertiary, aimed at three distinct audiences:  mental health and psychosocial specialists, other frontline practitioners, and engaged adult bystanders and youth.

You will hear the term multi-stakeholder prevention framework to describe a consortium or network between different types of governmental and civil society organizations. This framework is intended to guide and improve communication, education, access, capacity, and impact in the service of preventing targeted violence. 

As a frontline practitioner, you will want to be aware of the existence of such a framework in your community. The stakeholders in this framework can provide you with sources for making referrals, expert consultation, training, and other resources. 

The public health approach should be regarded as a supplement to more law-enforcement-centered approaches to targeted violence.  The public health approach is especially important for identifying strategies for modifying individual behavior and/or social determinants. It can also help in building effective and scalable prevention programs, as described above.